Lexapro vs. Paxil

See how Lexapro and Paxil compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Both are SSRIs, but Lexapro is approved for major depressive disorder in adolescents 12 to 17, while Paxil is approved only for adults.

  • Paxil covers a wider range of FDA-approved uses, including OCD, panic disorder, PTSD, and social anxiety disorder, while Lexapro is approved for depression and generalized anxiety disorder.

  • Paxil's common side effects occur at higher rates than Lexapro's, and its short half-life can make it harder to stop without withdrawal symptoms.

Lexapro vs. Paxil Drug Summary

Lexapro

Lexapro (escitalopram) is a selective serotonin reuptake inhibitor used to treat major depressive disorder in adults and adolescents 12 and older, as well as generalized anxiety disorder in adults. It's taken once daily as a tablet or oral solution, usually starting at 10 mg with an option to increase to 20 mg after two weeks.

Paxil

Paxil (paroxetine) is an SSRI approved for major depressive disorder, OCD, panic disorder, social anxiety disorder, generalized anxiety disorder, and PTSD in adults. It's taken once daily as a tablet, extended-release tablet, or oral suspension, with doses ranging from 20 mg up to 50 mg depending on the condition treated.

Lexapro vs. Paxil Side Effects

Lexapro

Most common
nausea (up to 15%)
somnolence (up to 6%)
insomnia (up to 9%)
ejaculation disorder (up to 9%)

Paxil

Most common
nausea (up to 26%)
somnolence (up to 23%)
asthenia (up to 15%)
constipation (up to 14%)

Lexapro vs. Paxil Dosage

Lexapro

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 20 mg once daily Week 2 onward
Maximum dose 20 mg once daily Same as starting
Dose changes None Fixed dose

Paxil

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 20 mg once daily At the start
Maximum dose 20 mg once daily Same as starting
Dose changes None Fixed dose

Lexapro vs. Paxil Indications

Lexapro

Lexapro is FDA-approved to treat major depressive disorder in adults and adolescents ages 12 to 17, along with generalized anxiety disorder in adults. It is not approved for depression in children under 12 or for any anxiety disorder in pediatric patients.

  • Major depressive disorder (adults and adolescents 12-17)

  • Generalized anxiety disorder (adults)

  • Not approved for MDD in children under 12

  • Not approved for GAD in pediatric patients

Paxil

Paxil is FDA-approved for a wider range of conditions, including major depressive disorder, obsessive-compulsive disorder, panic disorder, social anxiety disorder, generalized anxiety disorder, and PTSD in adults. It is not approved for use in any pediatric population.

  • Major depressive disorder (adults)

  • Obsessive-compulsive disorder (adults)

  • Panic disorder (adults)

  • Social anxiety disorder (adults)

Lexapro vs. Paxil Pros and Cons

Lexapro

Lexapro has a simpler once-daily dosing schedule with only one dose increase, and its side effect rates are generally lower than Paxil's. It also carries FDA approval for use in adolescents with depression, a group Paxil is not approved to treat.

Pros

  • Approved for depression in adolescents 12-17

  • Lower side effect rates than Paxil

  • Simple two-step dosing: 10 mg then 20 mg

  • Minimal CYP2D6 drug interaction risk

Cons

  • Narrower approval: only MDD and GAD

  • Roughly $440 to $603 per month, pricier than Paxil

  • No extended-release or oral suspension option

Paxil

Paxil covers a broader range of anxiety-related conditions than Lexapro, including OCD, panic disorder, and PTSD. Its side effect rates tend to run higher, and its strong CYP2D6 inhibition means it interacts with more medications than Lexapro does.

Pros

  • Approved for six conditions, including OCD, PTSD, panic disorder

  • Roughly $300 to $310 per month, less costly than Lexapro

  • Available as tablet, extended-release tablet, or oral suspension

  • Long safety record since FDA approval in 1992

Cons

  • Higher rates of nausea, somnolence, and dry mouth

  • Strong CYP2D6 inhibitor, complicating many drug combos

  • Short half-life linked to more difficult discontinuation

Common Symptoms and Related Diseases You Can Explore

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